Port Louis — The ministry of Health congratulates itself on sending more and more Mauritians for surgery abroad. While this is positive for the patients involved, it reveals a serious lack in the provision of health care, especially in the neurosurgery sector.

When the words "ministry of Health" or "hospital" appear in the local press, readers are sure that they will find in the lines which follow things like "crisis", "mismanagement", "medical negligence", "squandering of public funds", "permanent break-down of high-tech equipment", " acute shortage of vital prescription drugs" or one of the thousand and one scandals our public hospitals are prone to.

These days, the ministry of Health has been boasting about the number of Mauritians sent abroad for surgery. This outsourcing of surgery is, in fact part, of a serious health mismanagement situation for a country seeking to be a medical hub in the region.

The health sector - the cardiac centre of Pamplemousses being perhaps the only exception - has not followed the economic miracle experienced by the country since the 80s. The quality of public health services is not always adequate and some of the doctors are poorly trained, inexperienced and work in conditions which allow them little time to allocate to each of the hundreds of out-patients they see daily. A terrible fl aw in the island's quest to attract billionaires of the world to buy property in its Integrated Resort Scheme, this inadequate situation is also considered, by some medical staff as a shame for a country whose Prime minister is a doctor who started his career in public hospitals.

"Anyone, from the billionaire to the pauper can find themselves with a severe head injury or brain damage through a stroke. These conditions are lethal without prompt neurosurgery. Yet, more than 20 years after the inception of a project for a neurosurgery unit with a dedicated staff and Intensive Care Unit, we are still fighting to get one and no private clinic is really equipped for neurosurgery," say neurologists at the Victoria Hospital according to whom Mauritius is squandering money by outsourcing neurosurgical operations abroad.

"We brought in a neurosurgeon of international reputation, professor Bhashkr of India, to operate on one of our patients. The operation went well, but complications followed. He did a second case and complications followed again. Then the professor realised that our post-operation staff, meaning the ICU and its staff were neither well equipped nor well trained to handle these patients. So he stopped everything," says Dr Amrit Rajkoomar who is presently doing his utmost to send at least five children this year for spinal neurosurgery in India.

The long waiting lists are also a problem, "When a child, usually a girl, is struck with scoliosis, a condition where the spinal cord starts to become deformed to the extent that the patient's body starts bending towards the right or the left, in Mauritian hospitals, they only give the patient another appointment in 4 months, and then at four month intervals. When pain comes on, they prescribe pain killers. But scoliosis needs early surgery and often, when the patients come to us, it is too late for surgery.

This year, we are sending five young girls to be operated on for scoliosis in Bangalore. Each operation will cost around Rs 450 000 and government will only give Rs 200 000. We will provide the rest," says Dr Amrit Rajkoomar of the NGO Society in Aid to Children Inoperable in Mauritius (SACIM).

Rs 200 000 per operation out of good taxpayers' money for dozens and dozens of patients while these operations could be carried out in Mauritius if the ministry of Health gives serious thought to creating a dedicated neurosurgery unit and a dedicated ICU for neurosurgery. "It is scandalous to note that a neurosurgery department was to be housed on the third floor of the new building housing the emergency department of Victoria Hospital. This third floor has been lying idle for more than three years since its construction and is leaking everywhere. We still do not have a dedicated ICU for neurosurgery or qualified nurses," says a neurosurgeon of the SSRN hospital who has asked for his name not to be published.

According to him, Mauritius cannot even carry out a cerebral angiography whilst it has one of the highest rates of diabetics and high blood pressure patients. "These patients are prone to strokes and ruptured aneurysms with massive brain bleeding and cerebral angiography is important as well as the coiling of ruptured brain arteries," says another surgeon. There are also allegations that children being sent to be operated on abroad may be a lucrative business for some members of staff and doctors in the ministry. To what extent this is true, only a serious enquiry by the ministry will be able to tell. Will they conduct one?!

Seeking aid from SACIM

The Society in Aid to Children Inoperable in Mauritius (SACIM) was set up mainly to send children with congenital heart problems for surgery abroad. Adults who could not afford to go abroad were left to fend for themselves and most cardiac patients were only put on medication. Heart surgery was unheard of. SACIM was in its hey day at that time and was sending around 10 children abroad for operations yearly.

But today, the country has a very modern and efficient cardiac centre, run by the Trust Fund for Specialised Medical Care in Pamplemousses. Its surgeons have even intervened with success on the hearts of new-born babies.

Three years ago, it was thought that SACIM had outlived its time and should be closed. This has not happened as bad times are back for children, mostly those needing neurosurgery. Around 10 will be sent abroad this year. Moreover, SACIM is also helping adults to find less costly hospitals for surgical operations abroad.

"Some operations may cost around Rs 3 or Rs 4 million in Australia or South Africa. With our contacts in India, we can have these operations done for Rs 400 000 in international class hospitals which mainly operate on foreigners in the course of their medical tourism policy," says Dr Amrit Rajkoomar. In fact, government, after inquiry, will only give Rs 200 000 and the patients' relatives have then to seek permission from the commissioner of police to raise funds from the Mauritian public.